Thromb Haemost 2013; 109(04): 585-588
DOI: 10.1160/TH12-08-0627
Viewpoint Article
Schattauer GmbH

Symptoms and clinical relevance: A dilemma for clinical trials on prevention of venous thromboembolism

Henri Bounameaux
1   Division of Angiology and Haemostasis and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
,
Giancarlo Agnelli
2   Internal and Cardiovascular Medicine – Stroke Unit, University of Perugia, Perugia, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 04. September 2012

Accepted after major revision: 23. Januar 2012

Publikationsdatum:
22. November 2017 (online)

Preview

Summary

The outcomes of thromboprophylactic trials have been debated for decades. Recently, the 9th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines based their strong recommendations only on patient-important outcomes. Practically, symptoms were considered the crucial element. Consequently, studies that primarily aimed at reducing venographic thrombi were considered less pertinent than studies that focused on symptomatic thrombosis. In the present viewpoint, we challenge the argument that “symptomatic” and “clinically relevant” are interchangeable. In particular, the case is made that asymptomatic events may be clinically relevant and that asymptomatic venographically detected thrombosis is a clinically relevant surrogate outcome for fatal pulmonary embolism.